title: Economic and clinical comparison of atypical depot antipsychotic drugs for treatment of chronic schizophrenia in the Czech Republic.
abstract: OBJECTIVE
  The Czech Republic is faced with making choices between pharmaceutical products, including depot injectable antipsychotics. A pharmacoeconomic analysis was conducted to determine the cost-effectiveness of atypical depots.
  
  
  METHODS
  An existing 1-year decision-analytic framework was adapted to model drug use in this healthcare system. The average direct costs to the General Insurance Company of the Czech Republic of using paliperidone palmitate (Xeplion®), risperidone (Risperdal Consta®), and olanzapine pamoate (Zypadhera®) were determined. Literature-derived clinical rates populated the model, with costs adjusted to 2012 Euros using the consumer price index. Outcomes included quality-adjusted life-years (QALYs), days in remission, and proportions hospitalized or visiting emergency rooms. One-way sensitivity analyses were calculated for all important inputs. A multivariate probability analysis was used to examine the stability of results using 10,000 iterations of simulated input over reasonable ranges of all included variables.
  
  
  RESULTS
  Expected average costs/per patient treated were €5377 for PP-LAI, €6118 for RIS-LAI, and €6537 for OLZ-LAI. Respective QALYs were 0.817, 0.809, and 0.811; ER visits were 0.127, 0.134, and 0.141; hospitalizations were 0.252, 0.298, and 0.289. Results were generally robust in sensitivity analyses. PP-LAI dominated RIS-LAI and OLZ-LAI in 90.2% and 92.1% of simulations, respectively. Results were insensitive to drug prices but sensitive to adherence and hospitalization rates.
  
  
  CONCLUSIONS
  PP-LAI dominated the other two drugs, as it had a lower overall cost and superior clinical outcomes, making it the preferred choice. Using PP-LAI in place of RIS-LAI for chronic relapsing schizophrenia would reduce the overall costs of care for the healthcare system.
authors.affiliation: University of Toronto, Toronto, Canada. t.einarson@rogers.com
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Einarson
authors.forename: Roman
authors.initials: R
authors.lastname: Zilbershtein
authors.forename: Jana
authors.initials: J
authors.lastname: Skoupá
authors.forename: Sárka
authors.initials: S
authors.lastname: Veselá
authors.forename: Madhur
authors.initials: M
authors.lastname: Garg
authors.forename: Michiel E H
authors.initials: ME
authors.lastname: Hemels
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D014150:Antipsychotic Agents / Q000191:economics* / Q000627:therapeutic use; D001569:Benzodiazepines / Q000191:economics / Q000627:therapeutic use; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D018153:Czech Republic; D003661:Decision Support Techniques; D003692:Delayed-Action Preparations / Q000191:economics / Q000627:therapeutic use; D016527:Drug Costs; D017850:Economics, Pharmaceutical; D005260:Female; D006801:Humans; D007555:Isoxazoles / Q000191:economics / Q000627:therapeutic use; D008297:Male; D015999:Multivariate Analysis; D000077152:Olanzapine; D000068882:Paliperidone Palmitate; D010168:Palmitates / Q000191:economics / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D018967:Risperidone / Q000191:economics / Q000627:therapeutic use; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations; D007555:Isoxazoles; D010168:Palmitates; D001569:Benzodiazepines; D018967:Risperidone; D000077152:Olanzapine; D000068882:Paliperidone Palmitate